Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months
Date
2024
Authors
Ertugrul, A.D.
Neto, A.S.
Fulcher, B.J.
Charles-Nelson, A.
Bailey, M.
Burrell, A.J.C.
Anderson, S.
Bernard, S.
Board, J.V.
Brodie, D.
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Advisors
Journal Title
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Volume Title
Type:
Journal article
Citation
Critical Care and Resuscitation, 2024; 26(4):262-270
Statement of Responsibility
Atacan D. Ertugrul ... Benjamin A.J. Reddi ... et al., on behalf of the EXCEL Study Investigators and the International ECMO Network (ECMONet)
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Abstract
Objective: Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes. Design, setting, and participants: This is a registry-embedded observational cohort study. Patients were included if they were enrolled in the binational ECMO registry (EXCEL). The exclusion criteria included patients on ECMO for heart/lung transplants. Data included demographics, clinical information on their first ECMO run, and six-month outcomes obtained by telephone interview. The primary outcome was death or new disability at six months. A multivariable analysis was conducted using hospitals' annual ECMO volume. High-volume centres were defined as having >30 ECMO cases annually, and analyses were run on ECMO subgroups of veno-venous (VV), veno-arterial (VA), and extracorporeal cardiopulmonary resuscitation (ECPR). Results: Of 1232 patients, 663 patients were cared for on ECMO at high-volume centres and 569 patients at low-volume centres. There was no difference in six-month death or new disability between high- and low-volume ECMO centres in VV-ECMO [OR: 1.09 (0.65e1.83), p ¼ 0.744], VA-ECMO [OR: 1.10 (0.66 e1.84), p ¼ 0.708], and ECPR-ECMO [OR: 1.38 (0.37e5.08), p ¼ 0.629]. This finding was persistent in all sensitivity analyses, including exclusion of patients who were transferred between high- and lowvolume centres. Conclusion: There was no difference in death or disability at six months between high- and low-volume centres in Australia and New Zealand, possibly due to the current model of coordinated care that includes patient transfers and training between high- and low-volume ECMO centres in our region.
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Dissertation Note
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© 2024 The Authors. Published by Elsevier B.V. on behalf of College of Intensive Care Medicine of Australia and New Zealand. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).